I’ve spent the last 15 years in the tech startup community including several early stage ventures with successful exits in the healthcare space. I'm also a Top Writer on Quora (2012 and 2013) for several healthcare specific topics. I'm likely to include film references and quotes as in "All of life's riddles are answered in the movies." Twitter handle is: @danmunro

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A Tribute To Healthcare's First Transparent Pricing Pioneer

Dr. Arnold “Bud” Relman passed away last Tuesday — on his 91st birthday. As the former Editor-in-Chief (1977 to 1991) of the prestigious New England Journal of Medicine, he was a pioneering and dominant voice against the wildly profitable “medical industrial complex” — a phrase he tweaked (in 1980) based on President Dwight D. Eisenhower’s ominous warning of a “military industrial complex.”

While we’ve become accustomed to the new shock-and-awe of healthcare pricing transparency, in many ways it was Dr. Relman who opened our collective thinking on the economical and ethical dilemma of a healthcare system optimized for revenue and profits — not safety and quality.

I also remember reading Dr. Relman’s moving and deeply personal encounter with our healthcare system just this last February —On Breaking One’s Neck— which is a testament to his indomitable spirit even at his advancing age. He ended the piece with this wink of a spousal warning:

As I wrote to my wife in one of my myriad scrawled notes the first week in the ICU, “I intend to hang around for a while longer, to love and bother you.”

Douglas Martin at the New York Times wrote a great piece on his life and the amazing history of this one doctor —Dr. Arnold Relman, Outspoken Medical Editor, Dies at 91— which I encourage everyone (especially those interested in “disrupting” healthcare) to read. His life and history is a testament to the arduous (and lengthy) battle ahead against this multi-headed beast known as the “medical industrial complex.”

To frame the label that Dr. Relman coined — it helps to envision it at the size and scale it has become. While much of it is life-saving and life-altering, most of it here in the U.S. is highly fragmented, episodic and extremely expensive. Even during Dr. Relman’s own patient experience earlier this year — he made this direct observation:

In the intensive care unit, after I recovered from the acute episode and at Spaulding—my main criticism was twofold. First, it wasn’t integrated. The care was rendered by individual specialists who didn’t seem to be working together. They were each doing his or her own thing, and there was no one person who was in charge. The other criticism I had was when it came to medication. They were too solicitious. They wanted to give me too much medication.Dr. Arnold Relman on becoming the patient — by Chelsea Conaboy for The Boston Globe — 1/28/2014

Of all the healthcare debates we’ve had — and the one’s ahead — the single largest one is the one we continue to avoid and the one that Dr. Relman identified so many years ago — the enormous profit in every direction within our medical industrial complex.

In tribute to Dr. Relman — I offer a few quotes that remind us of his legacy — and the larger mission he committed his life to influencing.

“Their joint crusade [Dr. Relman and Dr. Angell], stated repeatedly in editorials for the journal and since expanded in books and dozens of articles in the lay press, is against for-profit medicine, especially its ancillary profit centers of commercial insurance and drug manufacture — in Dr. Relman’s words, “the people who are making a zillion bucks out of the commercial exploitation of medicine.” The New York Times — A Drumbeat On Profit Takers

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” Drug Companies and Doctors: A Story of Corruption — Marcia Angell (wife and Editor of NEJM with Dr. Relman) — The New York Review of Books (2009)

“The experts talk about the [healthcare] problems that lie ahead in cascades. First, there is what you might call the structural cascade. Then there is the technical cascade. Then there is the cost cascade. Nearly everybody not in the employ of the administration agrees this law does not solve the cost problem, and many of the recent regulatory decisions will send costs higher.”Health Chaos Ahead— David Brooks — The New York Times

“There are nearly 1 million Americans who visit the emergency room each year because of dental pain at a cost that runs into the hundreds of millions.” Miles O’Brien — Science Correspondent, PBS NewsHour — Frontline — Dollars and Dentists — June 2012

“Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says. That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.” Marshall Allen — How Many Die From From Medical Mistakes in U.S. Hospitals? — ProPublica

Many of the healthcare pricing questions on the road ahead can trace their roots to the one Dr. Relman had the audacity to ask as a headline — back in 1991. It included this quote — as relevant today as it was almost a quarter of a century ago.

“Today’s market-oriented, profit-driven health care industry therefore sends signals to physicians that are frustrating and profoundly disturbing to the majority of us who believe our primary commitment is to patients. Most of us believe we are parties to a social contract, not a business contract. We are not vendors, and we are not merely free economic agents in a free market. The Health Care Industry: Where Is It Taking Us? Arnold S. Relman, M.D. — New England Journal of Medicine — September 19, 1991

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